Avoiding Medicare Denials for Lab Tests

Imagine how frustrating it is for a patient to be billed full cost by the laboratory for a test that was previously covered in the past.  It generates the unecessary extra work of dealing with phone calls from unhappy patients or balance billing patients for “uncovered” tests

You can avoid this problem for both your patients and your billing department by knowing which ICD10 diagnosis codes establish medical necessity for performing a specific lab test.

Centers for Medicare and Mediciad Services (CMS) publishes these codes in “Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM)”.

To obtain the most recently updated version, it is recommended you Google search for  “Medicare National Coverage Determinations (NCD) Coding Policy Manual” rather than go to a specific link for a recent update such as:

https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/Downloads/manual201801_ICD10.pdf

This will ensure you always find the current version.